title: Direct, indirect, and intangible costs after severe trauma up to occupational reintegration - an empirical analysis of 113 seriously injured patients.
abstract: OBJECTIVE
  Although seriously injured patients account for a high medical as well as socioeconomic burden of disease in the German health care system, there are only very few data describing the costs that arise between the days of accident and occupational reintegration. With this study, a comprehensive cost model is developed that describes the direct, indirect and intangible costs of an accident and their relationship with socioeconomic background of the patients.
  
  
  METHODS
  This study included 113 patients who each had at least two injuries and a total Abbreviated Injury Scale (AIS) greater than or equal to five. We calculated the direct, indirect and intangible costs that arose between the day of the accident and occupational reintegration. Direct costs were the treatment costs at hospitals and rehabilitation centers. Indirect costs were calculated using the human capital approach on the basis of the work days lost due to injury, including sickness allowance benefits. Intangible costs were assessed using the Short Form Survey (SF-36) and represented in non-monetary form. Following univariate analysis, a bivariate analysis of the above costs and the patients' sociodemographic and socioeconomic characteristics was performed.
  
  
  RESULTS
  At an average Injury Severity Score (ISS) of 19.2, the average direct cost per patient were €35,661. An average of 185.2 work days were lost, resulting in indirect costs of €17,205. The resulting total costs per patient were €50,431. A bivariate analysis showed that the costs for hospital treatment were 58% higher in patients who graduated from lower secondary school [Hauptschule] (ISS 19.5) than in patients with qualification for university admission [Abitur] (ISS 19.4).
  
  
  CONCLUSIONS
  The direct costs of treating trauma patients at the hospital appear to be lower in patients with a higher level of education than in the comparison group with a lower educational level. Because of missing data, the calculated indirect costs can merely represent a general trend, so that the bivariate analysis can only be seen as a starting point for further studies.
authors.affiliation: Institute for Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Anders
authors.forename: Oliver
authors.initials: O
authors.lastname: Ommen
authors.forename: Holger
authors.initials: H
authors.lastname: Pfaff
authors.forename: Markus
authors.initials: M
authors.lastname: Lüngen
authors.forename: Rolf
authors.initials: R
authors.lastname: Lefering
authors.forename: Sonja
authors.initials: S
authors.lastname: Thüm
authors.forename: Christian
authors.initials: C
authors.lastname: Janssen
keywords: direct costs; indirect costs; intangible costs; socio-economic status; trauma